Marriner Tomey: Guide to Nursing Management and Leadership, 8th c.

c. Called the business office for a list of medical diagnoses

Edition d. Assessed each client on the floor to find those whose status was
“critical”

Chapter 1: Communications 10. A group of nursing assistants approached the nurse manager to discuss
1. The nurse manager instructed the nursing assistant to “rinse her hands pay raises on another unit. This is a form of:
after touching the patient.” The nurse manager meant for the nursing a. Upward communication
assistant to use universal precautions. Which part of the communication b. Lateral communication
process was compromised? c. Diagonal communication
a. Ideation d. Informal communication
b. Encoding
c. Transmission 11. The staff nurse was providing discharge instructions to the client. After the
d. Receiving nurse discussed the importance of making an appointment the following
week for a follow-up visit with the physician, the client said, “I wonder if I
2. The client complains to the nurse about the noise at the nurse’s station at can go visit my daughter who lives out of town next week.” The nurse
night. The nurse’s best response is: determined that the client:
a. “I appreciate your reporting this to me.” a. Used selective perception to hear what she wanted to hear
b. “Thank you for contributing this information.” b. Decided not to see the physician for a follow-up
c. “What do you want me to do about this?” c. Had poor cognitive abilities
d. “Are you saying that you are unable to rest at night because of the d. Mistrusted the nurse's instructions
noise?”
12. A staff nurse was approached by a nursing assistant who wanted to give a
3. During a unit meeting, the nurse manager discusses ways to deal with a report about a client’s condition. The nurse said, “I don't have time to listen
hostile patient. The staff nurse suggests that more time be spent with the right now.” This is an example of:
patient. How does the nurse manager enhance the value of the staff nurse’s a. Upward communication
suggestion? b. Barrier to communication
a. Identify the staff nurse’s merits c. Downward communication
b. Dismiss what the staff nurse said d. Grapevine communication
c. Enhance the value of the unit
d. Accept others’ suggestions without regard to the staff nurse’s 13. Two nurses, one male and one female, were discussing client assignments.
suggestion Which of the following best illustrates gender differences between these two
colleagues?
a. Male: “I think the client needs to have a nursing assistant assigned on
4. The nurse educator begins the presentation on group process by asking the a one-to-one basis.”
participants to sit in a circle. The nurse educator’s use of this physical Female: “I agree with you.”
arrangement relates to which aspect of communication? b. Male: “I think the client is experiencing a loss related to the fact that he
a. Strategy is no longer the breadwinner of the family.”
b. Structure Female: “I think the client is grieving.”
c. Support c. Male: “I wonder if the client has expressed to his family his feelings of
d. Style loss.”
Female: “I think he is dealing with his feelings.”
5. The school nurse wants to use a PowerPoint presentation to educate d. Male: “I plan to care for the client as part of my assignment—he will
adolescents on sexually transmitted diseases. This method of presentation confide in me because I am a male.”
relates to which aspect of communication? Female: “I am just as competent to care for the client as you are.”
a. Supplement
b. Style 14. Which of the following cultures views eye contact as indicating
c. Structure trustworthiness?
d. Strategy a. Hispanic Americans
b. Asian Americans
6. For the nurse educator to prepare PowerPoint presentations, the nurse c. White Americans of European origin
must be able to use which of the following? d. Native Americans
a. Palm Pilot
b. Presentation software 15. In assessment of cross-cultural communication, which nonverbal behavior
c. Spreadsheet software is the most important?
d. Handheld computers a. Placement of hands
b. Facial expression
7. The nurse manager of a medical unit wants to assess how many clients c. Use of words
develop urinary tract infections on the unit. The best way to collect and d. Eye contact
catalog this information is to use what type of software?
a. Calendar and scheduling software 16. A nurse educator is developing a presentation for a group of senior citizens.
b. Word-processing software The nurse has 10 typewritten pages of notes and 20 PowerPoint slides for a
c. Presentation software 30-minute presentation. Which method of communication will enhance
d. Database software learning?
a. Continue lecturing for the 30 minutes
8. A rural health nurse is evaluating the use of a telehealth system for the rural b. Reduce the number of PowerPoint slides and use shorter sentences if
health clinic. Using this type of information technology can violate a client’s possible
rights when personnel: c. Cover topics related to careers for the senior citizen
a. Disseminate client information to a local physician d. Provide copies of notes to the senior citizens
b. Disseminate client information to nearby hospitals
c. Disseminate the client's password for easier access 17. The best response for the nurse manager to use with an angry employee is:
d. Disseminate client information to third-party reimbursers a. “What is wrong?”
b. “You are really inappropriate with your anger.”
c. “If you would like to talk, we can go into my office.”
d. “I'm not sure why you are angry, but don’t take it out on me.”
9. The chief executive officer (CEO) of the institution asked the nurse
manager to compile data on how many clients on the unit were considered 18. In a unit meeting, a staff nurse exhibits what is commonly known as an
to have a status of “critical.” Using upward communication, the nurse adult tantrum. The nurse manager’s best response is to:
manager: a. Call the staff nurse by name
a. Reviewed the charts and reported the data to the CEO b. Discourage the staff nurse from talking
b. Called a meeting of team leaders to discuss the status of clients c. Allow the staff nurse to finish the outburst
 d. Ask the staff nurse open-ended questions a. State in life (e.g., single versus married)
b. Age
19. During a performance evaluation, the staff nurse tells the nurse manager, c. Job occupation
“I'm not the only one who takes a long lunch break, so I shouldn't be d. Person’s perceptions
penalized for doing that.” The nurse manager understands that the staff
nurse’s behavior is that of: 4. Which of the following people is more likely to
a. An exploder experience burnout?
b. A sniper a. A nurse who just celebrated her fifth year with the agency
c. An unresponsive person b. A nurse manager who works 50 hours a week
d. A complainer c. A nursing assistant who just returned from vacation
d. A unit secretary who would like to return to school
20. Which of the following is indicative of trashing other nurses?
a. Nurses working together as a team 5. A nurse manager complains to another nurse about a
b. Nurses committing themselves to actions that they do not complete new graduate who just began working on the unit. The nurse manager’s
c. Nurses identifying with their male colleagues behavior can best be described as:
d. Nurses talking about other nurses behind their backs a. Workaholism
b. Chronic fatigue
21. A staff nurse exploded angrily at the charge nurse and said, “I don't have c. Burnout
time to turn the client because I have to catch up on my charting.” The d. Eustress
charge nurse replied, “I want to see you in my office right now!” This is an
example of what type of transactional pattern? 6. A staff nurse was promoted to unit manager. Which
a. Adult to adult technique can the staff nurse use to manage the stress associated with this
b. Child to child change?
c. Parent to parent a. Become more authoritative
d. Parent to child b. Request a pay raise
c. Set aside time to observe respected leaders or managers
22. A staff nurse left the unit in anger. She told the nurse manager, “I would d. Set aside time to inventory the unit’s weaknesses
have gotten that promotion if it weren’t for you.” What type of game was the
staff nurse playing?
a. Blame others 7. A staff nurse felt anger about the poor care an elderly
b. Attack client received at a long-term care facility. The nurse probably used what
c. Self-pity technique to identify this anger?
d. The corner a. Time blocking
b. Value clarification
23. The nurse manager was commenting to her staff about the overtime hours c. Goal setting
she was putting in because of a shortage of nurses. This is an example of d. Feeling pause
what type of game?
a. Blame others 8. A physician referred a client to the pain management
b. “Poor me” clinic for biofeedback treatments to help with migraine headaches. The
c. The corner nurse teaches the client that biofeedback:
d. The bear trapper a. Helps to get rid of negative thinking
b. Is the process of shouting “I feel …” inside one’s head
24. Which of the following people have a life position that indicates “I'm OK, c. Is a method of changing jobs
you're not OK”? d. Is a method of gaining self-regulation to control autonomic responses
a. People who assume that they are less competent and less influential
than others 9. An alcoholic client is being discharged. To help
b. People who feel OK about themselves and others enhance the client’s self-esteem, it would be most appropriate for the staff
c. People who supervise others closely because they feel others cannot nurse to provide information about:
be trusted a. Taking a vacation alone
d. People who lack confidence in themselves and trust others b. Self-help support groups
c. Referral sources
25. A staff nurse complained to the nurse manager that she was too tired to d. Nutritional support
continue a schedule that required her to double back to work. The nurse
manager responded, “I understand that you get tired when you double 10. A confused, agitated client was placed in the
back.” The nurse manager was demonstrating which assertive technique? seclusion room on the psychiatric unit. The client requested to see a doctor.
a. Broken record Which of the following actions taken by the nurse manager would be most
b. Fogging likely to prevent possible workplace violence?
c. Negative assertion a. Having a nursing assistant stay with client in the seclusion room
d. Negative inquiry b. Placing the client in a semiprivate room
c. Trying to orient the client to time and place
d. Prohibiting employees from entering the seclusion room alone
Chapter 2: Stress Management
11. The house supervisor is attempting to maximize his
1. The nurse manager was orienting a new staff nurse to managerial time. Which of the following techniques can he use to maximize
the unit. The nurse manager identified the staff nurse’s stress level when his time?
the staff nurse said: a. Delegation
a. “I'm so excited about this new job!” b. Abdominal breathing
b. “Is my license on the line if the equipment malfunctions?” c. Compartmentalization
c. “I realize I’m just out of school, but I’m willing to learn.” d. Anchoring
d. “How long is orientation?” 12. What could a registered nurse (RN) delegate to a
licensed practical nurse/vocational nurse (LPN/VN) that the RN could not
2. The nurse manager was reprimanding the nursing delegate to a nursing assistant?
assistant for clocking in late 3 days in a row. Which statement indicates the a. Making beds
greatest source of stress for the nursing assistant? b. Ambulating the client
a. “I’m sorry I am late. I have no excuse.” c. Administering oral medications
b. “I'm not the only one who clocks in late.” d. Obtaining a urinary specimen
c. “I'm getting married this weekend.”
d. “I need to get my cup of coffee.” 13. The charge nurse finished assessing the clients. In
making assignments, which would be a priority?
3. In teaching a stress management workshop, the a. Assign a nursing assistant to stay with a preoperative surgical client
nurse educator emphasizes that which of the following determines how one who was crying
responds to stress?
b. Assign a licensed practical nurse/vocational nurse (LPN/VN) to start an a. Nurse’s aide giving a report to the physician
intravenous line in a client who was bleeding rectally b. Nurse’s aide giving a report to the team leader
c. Assign an LPN/VN to perform an initial assessment of a newly admitted c. LPN/VN giving a report to the pharmacist
client d. LPN/VN giving a report to the house supervisor
d. Assign a nursing assistant to remove stitches from a postoperative
client who is preparing to be discharged 24. A nurse manager wants to ensure appropriate
delegation to a staff member. To do that, the manager should be familiar
14. The nurse manager delegated the task of making with all but which of the following?
client assignments to the staff nurse. How would the nurse manager a. The job description for the staff member
evaluate the results of the delegation? b. The educational background of the staff member
a. Ask other staff to supervise the nurse manager’s work c. The skills checklist or certifications of the staff member
b. Ask personnel if they are happy about the assignments d. The attitudes of other staff toward that staff member
c. Correct the staff nurse’s work
d. Use performance standards to evaluate 25. An important way for nurse managers to maximize
organizational time is to:
15. After delegating to the staff nurse the task of a. Use passive-aggressive communication with others
scheduling, the nurse manager plans to provide support by: b. Delegate all aspects of nursing care to nursing assistants
a. Sharing information c. Teach others how to do the work instead of doing it themselves
b. Criticizing how the staff nurse completes the task d. Look the other way when conflict arises
c. Assuming authority over the project
d. Maintaining liability
Chapter 3: Decision-Making Process and Tools
16. Which of the following indicates that the nurse is
culturally sensitive?
a. Allowing a Hispanic-American client’s extended family into the room 1. A staff nurse was asked by the nurse manager to be
b. Talking loudly to an Asian-American staff nurse the charge nurse because of the staff nurse’s long history of effective
c. Firmly shaking hands with a Native American client decision making. The staff nurse attributed her effective decision making to:
d. Standing face to face with an African-American staff nurse a. Minimal knowledge
b. The nurse manager’s modeling of effective decision making
c. Good decision making by the physician
17. The nurse manager stayed 2 hours late each night for d. Supportive hospital personnel
a week developing new policies and procedures for the unit. This is an
example of: 2. In the decision-making process, the nurse identifies a
a. Shared governance problem by:
b. Underdelegating a. Referring to the standards of practice
c. Overdelegating b. Using the nurse’s own experience
d. Procrastination c. Drawing on his or her education
d. Analyzing available information
18. A staff nurse complained that she was being a “gofer”
for the nurse manager without any recognition for doing the extra work of 3. Which of the following is an example of effective
developing policies. So the staff nurse decided not to continue working on decision making?
the policies. This is an example of: a. Counseling an employee for taking off one sick day
a. Underdelegation b. Implementing changes before explaining them to the staff
b. Overdelegation c. Including staff from one shift to help make a decision
c. Procrastination d. Implementing the decision that has been made
d. Lack of self-confidence
4. Traditionally, a hospital cuts back on registered nurse
19. Which of the following is one reason a staff nurse staffing for budgetary reasons. The hospital chief executive officer (CEO)
might not accept a delegated task? wanted to decrease the operating budget by reducing the number of travel
a. Lack of guidelines to complete the task nurses being used on the units. The nurse managers protested this
b. Lack of confidence in the nurse manager. decision loudly because they feared a resulting shortage of staff. The
c. Lack of understanding of organizational objectives hospital CEO used what type of decision-making model?
d. Lack of cooperation of other staff nurses a. Rational model
b. Bureaucratic model
20. A staff nurse was ordering supplies for the unit. After c. Political model
several interruptions, the nurse put down the order form and walked away d. Collegial model
from the task. This is an example of:
a. Underdelegating 5. The nurse manager expected her staff to be able to
b. Nonemotional procrastination log into evidence-based practice websites to update policies and
c. Emotional procrastination procedures. This is an example of what element of reasoning?
d. Planning a. Purpose or goal
b. Question at issue
21. A staff nurse put off charting until near the end of the c. Frame of reference
shift change. To stop the procrastination, the nurse manager suggested that d. Empirical dimension
the staff nurse:
a. Make a commitment to finish 6. The staff nurse is assessing the need for further
b. Needs to choose a pleasant task teaching for a preoperative surgical client. Based on the steps of critical
c. Delegate the charting to other staff nurses thinking, what is the nurse’s first priority?
d. Depend on the nurse manager to chart a. Identifying the problem
b. Developing a frame of reference
22. To implement a new staffing schedule based on c. Identifying implications and consequences
acuity levels, the nurse manager established time estimates for nursing d. Implementing inferences and conclusions
duties. This is an example of maximizing organizational time by:
a. Planning 7 The nurse manager of the labor and delivery room
b. Organizing sees the need to develop a new policy that allows members of the extended
c. Staffing family into the delivery room. This policy change would have to be
d. Directing presented to the medical staff. What type of structure would the nurses use
to develop the new policy?
23. Organizational charts help clarify who is responsible a. Task force
to whom and for what. Which of the following is an example of the use of an b. Ad hoc committee
organizational chart? c. Formal committee
d. Line committee new staffing policy, the nurse manager decided to have the staff rank the
suggestions in order of most preferred solution after considering whether
each suggestion is practical, cost effective, efficient, and effective. Next, the
staff prioritized the list, eliminated items, and added others. This is a form
8. Three charge nurses were assigned by the nurse of:
manager to develop a method for keeping the crash cart stocked after each a. Visual identification of relationships
shift. What type of structure would best accomplish this assignment? b. Checklist method
a. Task force c. Modeling
b. Ad hoc committee d. Self-interrogation checklist
c. Informal committee
d. Line committee 17. A staff nurse ridiculed another staff nurse’s draft of
the designs for new signs that were to be placed on the unit. The staff nurse
9. The hospital holds weekly meetings of a nurse who was ridiculing was demonstrating:
manager council that discuss identified problem areas and makes a. Objectivity
recommendations to a central council or administration. This is a form of: b. Ability to find problems
a. Ad hoc committee c. Negative attitude
b. Informal committee d. Tolerance for complexity
c. Shared governance council
d. Task force 18. A hospital planned to begin using a new computerized
medication administration record. The hospital used an external consultant
10. The nurse manager wants to ensure that consensus to act as a change agent and educate the staff. An advantage to using
has been reached at the monthly staff meeting. Consensus occurs when external consultants is that they:
the committee members agree that they can live with the decision even if it a. Will devote more time to the problem
is not the decision they would prefer. One way for the nurse manager to b. Are less costly
help build consensus among the committee members is to: c. Have limited backgrounds
a. Help them understand their responsibilities d. Bring new ideas and different perspectives to the situation
b. Evaluate their work
c. Implement their decisions 19. The nurse manager put up a rotation schedule to
d. Involve them in critical and creative thinking ensure that the holidays would be covered. The manager scheduled a
newly hired staff nurse for the same time slot as a nurse who had seniority.
11. An ad hoc committee was formed to collect data The nurse manager was demonstrating what ethical principle?
about the increase in absenteeism throughout the hospital. To ensure that a. Autonomy
this ad hoc committee functioned efficiently, the hospital limited the number b. Fidelity
of committee members to: c. Justice
a. 8 d. Utility
b. 3
c. 20 20. A staff nurse witnessed a hospital staff member who
d. 18 was finishing up the night shift stuff her pockets with extra rolls of tape. The
hospital has a policy about unauthorized removal of supplies from the unit.
12. During a staff conference, the issue of mandatory in- The staff nurse reported the incident to the nurse manager. Instead of
service sessions was raised. The staff from the day shift wanted the in- reporting the hospital staff member to the house supervisor, the nurse
service sessions to be held from 12:00 to 1:00 PM, so they could eat lunch manager counseled the staff member in the nurse manager’s office. This is
together. Some of the newer staff members who worked nights remained an example of what type of ethical position?
silent. When it came time for the vote, the majority who worked days and a. Utilitarianism
evenings accepted the time for the in-service sessions. The night shift b. Formalism
members did not promote this new schedule. This form of peer pressure is: c. Egoism
a. Consensus building d. Rule ethics
b. Groupthink
c. Ad hoc committee 21. The client’s bed linens were damp from excessive
d. Task force perspiration. The staff member helped the client take a bed bath, even
though the client had requested that she not be bathed. The nurse’s action
13. The nursing home staff members were brainstorming exemplified what model of ethical relationship?
about ways to keep one of the residents from walking into other residents’ a. Priestly model
rooms uninvited. After they failed to agree on a solution, the nurse manager b. Engineering model
instructed the staff members to take a break for lunch. The nursing c. Contractual model
manager was practicing what phase of creative decision making? d. Collegial model
a. Preparation
b. Incubation 22. Staff nurses use individual justice to care for
c. Illumination individual clients, but nursing leaders use what type of justice?
d. Verification a. Formal justice
b. Distributive justice
14. A nurse manager asks the staff members, “What c. Resourceful justice
causes low morale?” This is an example of which of the following? d. Merit justice
a. Meditation
b. Keeping an ideas diary 23. For nurses to function in a multicultural environment,
c. Reverse brainstorming they must be aware of global ethics. Which of the following is an example of
d. Brainstorming global ethics?
a. An African-American woman wants a midwife to deliver her baby.
15. The nurse manager at a nursing home wanted to use b. The nurse treats the clients on the unit impartially.
creative thinking to solve the problem of residents’ borrowing each other’s c. Nurses and clients work interdependently to plan care.
cigarettes without permission. First, the nurse manager called two licensed d. Clients depend on the nurses for all of their needs.
staff members into her office to discuss the problem. Next, she called in the
nursing assistant to join the group. Finally, she called in the social worker to 24. The nurse manager formed a task force of orthopedic
join the group. The nurse manager employed which technique to solve the staff nurses to develop cost-saving standard practices for the care of clients
problem? undergoing total hip replacement. The staff nurses used which type of
a. Ladder of abstraction decision-making model to reduce costs for clients undergoing total hip
b. Think tanks replacement?
c. Stepladder technique a. Program Evaluation and Review Technique (PERT)
d. Delphi technique b. Gantt chart
c. Decision trees
16. After a brainstorming session on how to implement a d. Critical path method (CPM)
 b. Positive valence and expectancy value of 0
25. Computers facilitate complex decision making. When c. Positive valence and expectancy value of 1
nurses use computers to track clients who were discharged based on d. Negative valence and expectancy value of 0
diagnosis-related groups (DRGs), they are using which type of computer
system? 9. According to Skinner’s positive reinforcement theory,
a. Clinical system a nurse manager needs to evaluate whether the desired results were
b. Dietary system obtained or not. If the desired results were not obtained, what is the nurse
c. Management information system manager’s first action?
d. Educational system a. Reassign tasks to different staff members
b. Assess the working environment for interference
c. Request staff to be reassigned to a different unit
Chapter 4: Motivation and Morale d. Reduce the number of hours staff members work

10. A staff nurse became upset with the hospital because

1. The staff nurses enjoyed meeting in the break room to newer nurses were being hired directly after graduation from nursing
share lunches and have some down time. The nurse manager had the staff programs at a higher pay than the nurse’s. Based on the equity theory,
break room converted to a family waiting room. The nurse manager was what would be expected from the staff nurse?
interfering with which staff need, according to Maslow’s hierarchy of needs? a. Pride in his performance
a. Physiologic b. Feelings of being overrewarded
b. Safety/security c. Decrease in productivity
c. Social/belonging d. Increase in productivity
d. Self-actualization
11. The nurse manager recently embraced a participatory
2. A rural hospital was forced to close because of style of management. After doing so, the nurse manager found that morale
financial problems. The staff and personnel were laid off. Based on and productivity were increased. Which of Douglas McGregor’s theories
Alderfer’s modified need hierarchy, the hospital administration interfered best describe this situation?
with which need? a. Self-determination theory
a. Safety/security b. Theory X
b. Existence c. Theory Y
c. Relatedness d. Theory W
d. Growth
12. Likert’s participative management theory differs from
3. Which of the following is an example of a motivation McGregor’s theory Y in that Likert’s research found that:
factor according to Frederick Herzberg’s motivation-hygiene (two-factor) a. Only general supervision is adequate
theory? b. More supervision leads to greater productivity
a. Nursing assistants’ working for a paycheck only c. Employee-centered supervision is more productive
b. Nurse manager’s interest in the prestige of the title d. Job-centered supervision is more productive
c. Administration’s interest in productivity only
d. Hospital’s funding of graduate courses for staff nurses
13. The hospital changed its management technique to
4. Which of the following is an example of a hygiene theory Z. Theory Z differs from other management theories in that theory Z:
factor in Herzberg’s two-factor theory? a. Focuses on productivity
a. Staff members’ concern that the hospital will lay off workers b. Focuses on institutional system
b. Hospital’s sponsoring of an awards banquet for all personnel c. Calls for the formation of quality circles to make decisions
c. Performance evaluations that provide positive feedback d. Calls for the development of strategic plans
d. Staff nurses’ attendance at workshops to increase knowledge
14. A staff nurse made a medication error. The nurse
5. The chief nursing officer evaluated an orthopedic floor immediately filled out an incident report, called the doctor, and notified the
because of complaints from staff about low morale. In the evaluation, the nurse manager. The staff nurse’s self-awareness and the ability to function
chief nursing officer found that the nurse manager was more interested in responsibly is an example of:
personal prestige than in achievement. According to McClelland’s basic a. Productivity
needs theory, the nurse manager has what type of need? b. Emotional intelligence
a. A need for advancement c. Empathy
b. A need for achievement d. High morale
c. A need for power
d. A need for affiliation 15. At the nurse managers’ council meeting, staff
tardiness was discussed. After returning to the unit, the nurse manager
6. The nurse manager received an award because the developed a log to track how often tardiness occurred and who was coming
manager’s staff had taken fewer sick days than staff in other units in the into work late. The nurse manager was demonstrating:
hospital. The nurse manager felt that the unit demonstrated high morale a. Accurate self-awareness
and high productivity. According to McClelland’s basic needs theory, the b. Service orientation
nurse manager was demonstrating what type of need? c. Leveraging diversity
a. A need for advancement d. Motivation
b. A need for achievement
c. A need for power 16. A nurse manager was having difficulty with the staff.
d. A need for affiliation Morale was low because of petty gossiping among the staff and intolerance
of each other’s behaviors. The nurse manager decided that the best way to
7. One of the staff nurses was attending graduate school handle this situation was to develop self-competence by:
to learn more about critical care. The nurse manager asked the staff nurse a. Attending a conflict management course
to develop policies and procedures for the new cardiac rehabilitation b. Being politically aware
program that was to be opened the next year. According to Argyris’s c. Being conscientious
psychological energy theory, the nurse manager was: d. Attending a service orientation program
a. Decreasing the staff nurse’s productivity
b. Increasing the staff nurse’s morale 17. The charge nurses inform the nurse manager that the
c. Matching the staff nurse’s talents with the job newly hired nurses are having difficulty with decision making and
d. Increasing the staff nurse’s motivation delegating. The best way for the nurse manager to handle this situation is to
send the charge nurses to:
8. A staff nurse delegated to a nursing assistant the task a. A conflict management course
of stocking the linen cart for the next shift. At the end of the shift, the staff b. A self-management course
nurse discovered that the linen cart was not stocked. According to Vroom’s c. A stress management course
expectancy theory, the nursing assistant was operating from: d. Supervisory training
a. Negative valence and expectancy value of 1
 a. Charismatic power
18. Newly hired nurses were having difficulty in b. Informal power
delegating tasks to the nursing assistants. They approached the nurse c. Coercive power
manager about setting up a leadership laboratory. The nurse manager d. Expert power
decided that the key component that needed to be taught was: 3. A staff nurse volunteered to serve on a newly formed
a. How to take care of one’s body task force charged with developing evidence-based practice protocols. This
b. How to accept feelings participation gave the staff nurse:
c. How to engage in responsible decision making a. Referent power
d. How to be successful b. Interpersonal power
c. Reward power
19. A staff nurse continually voiced complaints to the d. Coercive power
nurse manager about the workload. The staff nurse was exhibiting:
a. High productivity 4. One of the nurse manager’s roles is to evaluate staff
b. High morale performance. Because the nurse manager has this role, the nurse
c. Low productivity manager's positional power is increased by:
d. Low morale a. Centrality
b. Criticality
20. Which of the following is an example of high c. Flexibility
organizational morale? d. Relevance
a. A staff nurse enjoys the quality of her work.
b. A staff nurse shows decreased quality of work. 5. A staff member has the authority to:
c. A staff nurse is loyal to the profession. a. Delegate to administrative staff
d. A staff nurse has a high rate of absenteeism. b. Implement ideas without approval from administration
c. Assist managers in the performance of their duties
21. A group of staff nurses met in the hospital cafeteria. d. Enjoy command privileges
They decided to write a letter to the nurse manager regarding the behavior
of another staff member. In the letter, they planned to ask that the staff 6. The nurse educator planned an in-service program on
member be removed. This is an example of: empowerment. The nurse educator could include discussion of which of the
a. High morale following ways that a staff member can empower himself or herself?
b. Burnout a. Be able to admit mistakes
c. Vertical violence b. Withhold information from others
d. Horizontal violence c. Decrease workload
d. Maintain a critical aloofness
22. A senior registered nurse (RN) was assigned to serve
as preceptor for a new RN for 6 months. By the end of the first month, the 7. The nurse manager’s vision was to empower the staff.
nurse manager observed the senior RN talking harshly to the new RN. The The nurse manager used all of the following techniques to help empower
best action of the nurse manager to reduce horizontal violence would be to: the staff except:
a. Ignore the senior RN’s actions a. Assigning big problems to the staff
b. Assign a senior licensed practical nurse to serve as preceptor for the b. Sharing task-related information
new RN c. Obtaining material resources so staff members can do their jobs
c. Mentor the new RN d. Providing emotional support
d. Validate assumptions and perceptions before drawing conclusions
8. A new staff member decided he wanted to work in an
23. The nurse manager observed that the patients’ trash institution where he could have a voice in policy formation. What type of
cans were not being emptied by the night shift personnel. The nurse institution would be the best fit for the staff nurse?
manager decided to set up a rotation schedule so that all night shift a. Home health agency
personnel would be responsible for emptying the trash cans. This is an b. Magnet institution
example of: c. Elementary school
a. Preventing workplace civility d. Community-based clinic
b. Preventing burnout
c. Preventing horizontal violence 9. A school nurse is following the legislative path of a bill
d. Preventing vertical violence that supports human papillomavirus immunization of high school girls. The
school nurse’s most effective political strategy is to:
24. The nurse manager compared the male and female a. Become emotionally involved
registered nurses (RNs) on the unit. The nurse manager found that which of b. Educate area nurses about the immunization bill
the following had the greatest influence on job satisfaction for male RNs? c. Refrain from attending town hall meetings
a. Social aspects of the job d. Discourage neighborhood petitions
b. Interpersonal relationships
c. Company management and policies 10. The nurse manager of a nursing home wants to
d. Working conditions address the legislature regarding the state’s position on the opening of new
facilities. To be the most effective in communicating this concern, the nurse
25. Nursing administrators were concerned about the cost manager decides to:
of replacing staff members. The reason for an increase of cost is: a. Call the legislative secretary
a. The work itself b. E-mail a letter to the legislative representative
b. The expense of the orientation period c. Have a petition signed and mailed to the legislative representative
c. Limited advancement potential d. Have a face-to-face meeting with the legislative representative
d. Increased recognition for achievement
11. A bill, HR 152, was originated by a group of nurses
lobbying Congress for staffing based on nurse-patient ratio. After it was
Chapter 5: Power, Politics, and Labor Relations originated, this bill then went to:
a. The president of the American Nurses Association
b. The primary sponsor
1. A staff nurse admires the nurse manager’s leadership c. A committee of the House of Representatives
style. What type of power does the nurse manager have in this situation? d. A committee of the Senate
a. Informal power
b. Coercive power 12. A nurse manager was invited to attend a public
c. Referent power hearing about whether the state needs to impose a moratorium on new for-
d. Information power profit health care agencies. The nurse understands that the bill addressing
this issue is in what phase of the legislative process?
2. A cardiac rehabilitation clinic hired a nurse practitioner a. The bill has been introduced in the Senate.
to manage the clinic. The nurse practitioner had recently obtained critical b. The bill has been referred to a standing committee.
care certification. What type of power does the nurse practitioner have?
c. The bill has been referred to a subcommittee.
d. The bill has been introduced in the House of Representatives. 22. Before an election is scheduled, the union’s
responsibility is to:
13. A staff nurse needs some time off to take care of her a. Get at least 10% of the nurses to sign individual authorization cards
critically ill mother. She does not want to quit her job, nor does she have b. Maximize the number of bargaining units
enough vacation time to take off. For the staff nurse to keep her job, she c. Schedule a preliminary hearing
needs to be aware of which labor law? d. Present solutions to the hospital management
a. The National Labor Relations Act
b. The Labor-Management Relations Act 23. The licensed staff members who belong to the union
c. The Nonprofit Health Care Amendments to the Taft-Hartley Act filed a grievance against the hospital related to the conditions of
d. The Family and Medical Leave Act employment. According to the National Labor Relations Board, in this
situation collective bargaining is:
14. Hospital employees decided that they would support a. Petitionary
the union certified by the National Labor Relations Board and go out on b. Illegal
strike. At what point in the unionization phase can striking occur? c. Voluntary
a. Organizing phase d. Mandatory
b. Recognition phase
c. Contract negotiation phase 24. The union has a security clause that requires all new
d. Contract administration phase employees to join the union. The security clause states that all members
must maintain their memberships during the duration of the contract. This is
an example of:
15. A nurse manager was hired after the hospital a. A closed shop
employees unionized. After a few days on the job, an employee on the unit b. A union shop
became angry at the staffing schedule the nurse manager had posted. The c. A maintenance-of-membership clause
employee filed what type of grievance? d. An agency shop
a. Harassment grievance
b. Political grievance 25. The nurse managers have been informed that
c. Imagined grievance employees have contacted a union and that the union is trying to solicit a
d. Informal grievance show of interest from 30% of employees. The nurse managers suggest
what method to help decrease the desire to form a union?
16. A nursing assistant complained to the nurse manager a. Collective bargaining
that a staff nurse was making sexually inappropriate statements. The b. Information technology
nursing assistant felt that the nurse manager did not adequately counsel the c. Participative management
staff nurse. After the nursing assistant filed a grievance, a hearing was held. d. Bureaucratic management
It is the nursing assistant’s responsibility to:
a. Hire an attorney
b. Obtain a witness Chapter 6: Conflict Management and Negotiatio
c. Leave the hospital because of conflict of interest
d. Obtain the services of the American Nurses Association 1. A nurse at a physician-run clinic tried to schedule an
operating room for an early morning outpatient surgery. The nurse manager
17. Which of the following is an example of unfair labor of the operating rooms did not have any available rooms until late
practices by management? afternoon, so the nurse manager refused the request. This resulted in what
a. Contributing financial support to the union type of conflict?
b. Supporting employees to develop a union a. Cultural conflict
c. Being unable to bargain with representatives b. Horizontal conflict
d. Allowing the selection of a representative c. Vertical conflict
d. Intradepartmental conflict
18. Which of the following statements about union labor
practices is untrue? 2. Although the house supervisor demanded a high
a. Union representatives must be able to bargain with the employer. quality of care, the nurse manager’s request for more staffing because of
b. The union may take a strike action without notifying the employer. increased patient acuity levels was denied. This action by the house
c. The union cannot boycott a hospital’s vendors. supervisor produced what type of conflict?
d. The union cannot cause the employer to pay for services not a. Intrasender conflict
performed. b. Person-role conflict
19. The hospital employees are proposing to form a c. Intragroup conflict
union. Which of the following persons do not have the right to vote on union d. Intergroup conflict
issues?
a. Nurse managers 3. After working several years in the hospital setting, a
b. Housekeeping personnel master’s-prepared nurse was hired at a local university. As a new faculty
c. Nursing assistants member, the nurse began to feel overwhelmed with the responsibilities of
d. Licensed personnel teaching, professional development, and community service. The nurse
was also expected to develop on-line courses using specific software.
20. After becoming unionized, hospital employees Which type of conflict did the faculty member experience?
become satisfied with the hospital’s acceptance of their demands regarding a. Intrasender conflict
staff-patient ratios. The employees then decide that they no longer want to b. Intersender conflict
be represented by the labor organization. The employees’ next step is to: c. Intragroup conflict
a. Initiate a decertification election with a 10% show of interest d. Role overload
b. Call a strike action toward the hospital
c. Initiate a decertification election with a 30% show of interest 4. A staff member came to the in-service session upset
d. Initiate a certification election with a 30% show of interest because it was her day off. She was wearing tight, revealing clothes. The
nurse manager realized that the staff nurse was demonstrating what
21. Certification of the employees’ bargaining unit was reaction to the conflict?
denied because of insufficient votes. The labor organization’s next step is a. Sublimation
to: b. Attention getting
a. Begin the decertification process c. Identification
b. Seek certification among the same employees d. Rationalization
c. Allow a 12-month moratorium and then seek certification again
d. Begin negotiations with the hospital’s management 5. After a physician reprimanded a staff nurse for not
reporting the patient’s vital signs, the staff nurse began experiencing a
severe migraine headache. The staff nurse then asked the nurse manager
if he could take a sick day and leave the unit. The staff nurse was coping
with the physician’s reprimand by:
a. Displacement a. Seducing the staff nurses
b. Denial b. Annoying the staff nurses
c. Somatization c. Demeaning the staff nurses
d. Regression d. Using a smoke screen approach

6. A staff nurse disagreed with the nurse manager’s 15. During the breakthrough negotiation between the
decision not to allow smoking breaks. The staff nurse then began hospital's unlicensed workers and the nurse manager of a unit, the nurse
discussing the decision with other members of the staff who smoked. The manager reframed a personal attack by the unlicensed workers by saying:
staff nurse escalated the conflict by: a. “I don't agree with you.”
a. Competition b. “I understand that you are angry.”
b. Bickering c. “How would you deal with the situation?”
c. Constriction of others d. “What do you think will happen if we reach agreement?”
d. Coalition formation
16. The licensed personnel were told that they could no
longer wear different-colored scrubs as their uniforms. They were told that
7. A rural hospital was switching to computerized they had to wear white uniforms. Because the licensed personnel were
charting. Many of the senior nurses were feeling anxious about the changes unionized, they refused to continue working until they could resume wearing
because of the new technology involved. In what stage of conflict were the different-colored scrubs. The best way for the nurse manager to handle this
senior nurses? situation would be to:
a. Latent a. Express the shared value of choice with the licensed personnel
b. Perceived b. Use the nurse manager’s authority and force them to comply
c. Felt c. Demonstrate acceptance of their request
d. Manifest d. Explore the reason for the resistance to wearing white uniforms

8. The nurse manager overheard a staff nurse say that 17. The hospital hired a consultant in the hopes of
she was sending out her résumé to other agencies. When the nurse developing:
manager tried to verify this information, the staff nurse denied that she was a. An adversary
looking for another job. The staff nurse was demonstrating what type of b. An opponent
conflict? c. An ally
a. Latent d. A bedfellow
b. Perceived
c. Felt 18. The hospital administrator insinuated that overtime
d. Manifest hours would be cut from a certain staff member’s work schedule. This staff
member had a history of complaining about the hospital’s policies. An
9. A physician reprimanded a staff nurse in front of a essential rule that the staff member needs to remember when negotiating is
patient about missing laboratory work in the chart. The staff nurse excused to:
himself and left the room without answering the physician. The staff nurse a. Show no fear
managed the conflict by: b. Be ready to be intimated
a. Avoiding c. Complain to others about the problem
b. Accommodating d. Be ready for the conflict
c. Compromising
d. Competing 19. Two staff members were experiencing an
interpersonal conflict. They agreed to have the nurse manager present
10. Which of the following is the most effective way to while discussing the problem. The nurse manager’s role would be that of:
manage conflict? a. Compromiser
a. Avoiding b. Collaborator
b. Compromising c. Mediator
c. Collaborating d. Complainer
d. Competing
20. The nurse manager of a long-term care facility was
11. Two staff nurses were unable to resolve their mediating an interpersonal conflict between a staff nurse and a nurse’s aide
differences regarding the number of assigned days they had to float to who worked together on the night shift. One strategy that the nurse
another unit. The two staff nurses agreed to ask the nurse manager to help manager used was to:
manage this conflict by: a. Allow each staff member to blame the other
a. Mediating b. Encourage the staff nurse to tell her side of the story
b. Planning c. Allow the nurse’s aide to tell the staff nurse which of her personality
c. Collaborating traits bothered him
d. Competing d. Encourage each staff member to listen to the other’s point of view

12. The union representative informed the hospital 21. An equipment sales representative made frequent
administrator that the staff members were planning to strike because of visits to a skilled nursing facility. During his visits, he continually asked one
failed negotiations regarding an increase in benefits. The union of the married staff nurses out to eat. The married staff nurse kept refusing
representative is engaged in what type of bargaining? his offer. One less direct way the staff nurse can deal with the equipment
a. Principle negotiation sales representative is to:
b. Distributive bargaining a. Provide him with a copy of the sexual harassment policy
c. Integrative bargaining b. Notify the medical director
d. Positional bargaining c. Lodge a complaint with the equipment company
d. Ignore the sales representative when he comes to the unit
13. The hospital administrator told the union
representative that the hospital would rather close down the unit than give 22. A nurse manager wanted to use the nominal group
pay raises to the staff. The union representative knew that this was a process as a team development technique to help resolve conflicts on the
calculated delay so that the staff nurses would not strike. This is an unit. The nurse manager asked each staff member to state his or her goal,
example of: which the manager then wrote on a chalkboard for all to see. What step of
a. Smoke screen the nominal group process was the nurse manager using?
b. Over the barrel a. Listing of ideas
c. Positional pressure tactics b. Round-robin sessions
d. Flattery c. Serial discussions for clarification
d. Preliminary vote
14. The hospital administrator began the bargaining
process with the staff nurses by sarcastically saying, “I know that you are 23. The nurse manager, using the nominal group
intelligent people.” The hospital administration was playing what dirty trick? process, made a list of ways to handle conflicts on the unit. The next step
was to decide who should be involved in decision making and who would c. Lillian Gilbreth
be responsible for implementing that decision. This is known as: d. Max Weber
a. A round-robin session
b. A negotiating session 8. The primary difference between the classical
c. Decision charting management theorists and the behavioral science theorists is that the latter:
d. Implementation charting a. Focus on productivity
b. Focus on social environment
24. Because of low morale and a high level of c. Focus on having a positive attitude toward people
territorialism, the unit personnel decided they wanted the administration to d. Focus on organizational structure
remove the new nurse manager. The unit personnel were exhibiting what
type of behavior? 9. Which of the following management theorists favored
a. Performance problems a division of work through specialization?
b. Bullying behavior a. Elton Mayo
c. Attendance problems b. Kurt Lewin
d. Healthy behavior c. Jacob Moreno
d. Henri Fayol
25. Because of an increased risk of workplace violence,
an urban medical center instituted a workplace violence prevention training 10. What might one find in Likert’s consultative system
program. All of the following are topics that need to be included except: that would be less likely in participative management systems?
a. Risk factors that contribute to assault a. Staff members’ ideas are sought.
b. Information on multicultural diversity b. Sometimes an informal organization resists the formal goals.
c. Approaches to dealing with individuals who have a stressful life c. Staff members feel free to discuss their jobs with the manager.
d. Ways of dealing with hostile persons d. Decision making is integrated throughout the organization.

11. Which theorist introduced the concept of management

Chapter 7: Theories of Leadership and Management Development by objectives as a way to manage managers?
a. Rensis Likert
b. Kenneth Blanchard
1. A newly hired staff nurse observed the nurse c. Peter Drucker
manager’s leadership style. The nurse manager used rules and policies to d. Tom Peters
guide the staff and expected compliance. The nurse manager’s leadership
style was: 12. Which of the following theorists stresses leadership
a. Shared governance that serves people?
b. Democratic a. Warren Bennis
c. Laissez-faire b. Robert Greenleaf
d. Bureaucratic c. Larry Spears
d. Peter Senge
2. The nurse manager sees herself as demonstrating
leadership skills based on the situation. She can be a follower as well as a 13. According to Peter Senge’s theory, all of the following
leader; she is aware of her behavior and the behavior of her followers. The are disciplines for building a learning organization except:
nurse manager’s leadership style is: a. Systems thinking
a. Transactional leadership b. Personal mastery
b. Integrative leadership c. Mental models
c. Transformational leadership d. Emotional competence
d. Situational leadership
14. The nurse manager demonstrates self-confidence in
3. Unit personnel have a great deal of respect for the his ability to lead. He also describes himself as a visionary with empathy.
nurse manager. Based on Fred Fielder’s contingency model of leadership, Daniel Goleman identifies this behavior as:
what situation helps the nurse manager to be effective? a. A servant leader
a. Unit environment b. A benchmark for excellence
b. Staff-to-staff relations c. An emotional intelligence competency
c. Positional power d. Contingent reinforcement leadership
d. Staff empowerment
15. The staff developer prepared a presentation for the
4. Hersey and Blanchard’s situational leadership theory hospital regarding diversity. What is the single most important factor
predicts the most appropriate leadership style based on which of the predicting successful implementation of a diversity program?
following variables? a. Nurses’ support
a. Readiness of followers b. Administrative support
b. Readiness of physicians c. Physicians' support
c. Readiness of nurses d. Stake holders’ support
d. Readiness of the organization
16. The chief nursing officer (CNO) scheduled
5. Transactional leadership focuses on management performance evaluations for one male nurse manager and one female
tasks and trade-offs in exchange for expected performance. In nurse manager. Which leadership skill would the CNO expect to find in the
transformational leadership, the nurse manager: leadership styles of both genders?
a. Sets goals for the employees a. Autocratic management style
b. Uses management by exception b. Aggressive communication skills
c. Focuses on day-to-day operations c. Skills in networking outside the organization
d. Encourages self-management d. Nondirective management style
6. Which of the following management theorists 17. The nurse applicant revealed during a job interview
established a work standard based on the effects of fatigue on work that he had undergone a below-the-knee amputation. After the interview,
performance? the nurse manager thanked the nurse for coming in but said she was sorry
a. Frederick Taylor that she would not be able to hire him (even though there were openings
b. Frank Gilbreth available). What law did the nurse manager violate?
c. Henry Gantt a. The Rehabilitation Act
d. Abraham Maslow b. The Civil Rights Act
c. The Americans with Disabilities Act
7. Which management theorist focused on the d. The Equal Employment Opportunity Act
organization as a whole rather than concentrating solely on production?
a. Frederick Taylor 18. Which kind of followers believe they must please the
b. Frank Gilbreth
boss? d. Strategic planning
a. Effective followers
b. Conformist followers 3. Which of the following best describes operational
c. Alienated followers planning?
d. Ineffective followers a. Planning that extends 3 to 5 years into the future
b. Planning that involves allocation of resources
19. A staff nurse did not agree with the nurse manager c. Planning that determines time frames
about the new staffing policy. What is the best way for the staff nurse to d. Planning that is done in conjunction with budgeting
handle the situation effectively?
a. Discuss the disagreement in a public forum 4. Strategic planning became prevalent in the health
b. Try to develop solutions to the problem care industry as a result of:
c. Bring up the problem during a Joint Commission survey a. Shifting of payments to the federal government
d. Tell the nurse manager that the manager’s decision was b. Reimbursement changes, which decreased competition
unprofessional c. Increase in the use of high-cost technology
d. Construction of more hospitals
20. A school nurse planned a health promotion program
on character development for a group of seventh-graders. Which behavior 5. Which of the following contributed to increased health
most likely prompted the school nurse to develop the program? care spending?
a. Increased teacher involvement a. Aging of the population
b. Manifestations of students’ trust of each other b. Increased numbers of people with private insurance
c. Students’ increasing use of sexual language while walking down the c. Decreased incidence of violence
halls d. Decreased use of technology
d. Decrease in sexual activity among teens
6. Chief executive officers began using strategic
21. Part of the performance evaluation for a staff nurse planning to manage the rising cost of health care by:
focused on ethics and character development. What kind of activity a. Focusing on pain management clinics
demonstrates to the nurse manager that a staff nurse has a healthy b. Seeking out partnerships
character? c. Increasing duplication of services
a. Declining civic responsibility d. Decreasing informal networking
b. Attempt to create a caring workplace
c. Promotion of exterior motivation 7. The nurse manager of a unit uses strategic planning
d. Excessive drinking leading to increased absenteeism when the manager:
a. Decreases staffing
22. Which professional statement makes it clear that a b. Increases duplication of efforts
nurse’s responsibility is first to the patient and second to the institution? c. Sets unrealistic goals
a. Nursing’s Social Policy d. Gives direction to the unit
b. Nursing’s Social Justice Policy
c. The Code of Ethics 8. The nurse manager participates in organizational
d. The bylaws of the American Organization of Nurse Executives planning by:
a. Identifying competing health care agencies
23. A staff nurse began a graduate program focusing on b. Identifying goals and objectives
health systems management. To be prepared as an effective leader in a c. Identifying new physicians
health care agency, the staff nurse would probably benefit the most from d. Identifying health care vendors
instruction in which area?
a. Information systems 9. A hospital was conducting an external assessment to
b. Computerized charting ascertain whether it could set up a satellite clinic within a 75-mile radius of
c. Computerized medical records the larger hospital. An example of a threat to the hospital’s proposal is:
d. Self-regulation of nursing practice a. New programs
b. Diversification
24. The primary difference between leadership and c. Decrease in the number of insured patients
management is that leadership is more outcomes oriented and d. Population growth
management is more:
a. Process oriented 10. The hospital’s business plans call for a market
b. Solutions oriented analysis. A market analysis includes:
c. Conflict resolution oriented a. Definition of the nature of the organization
d. Organization oriented b. A resource analysis
c. Determination of the developmental costs of projects
25. Which of the following trends is most important for the d. Formulation of alternative strategies
twenty-first-century leader and manager?
a. Shortage of health care facilities 11. In a hospital setting, the lower-level managers carry
b. Spread of Asian flu out operational planning of daily, weekly, and monthly activities. An
c. Shortage of medication example of a lower-level manager is:
d. Globalization a. The chief nursing officer
b. A unit supervisor
c. A clinical nurse specialist
Chapter 8: Strategic and Operational Planning d. A case manager

12. In a hospital, which of the following influences the

1. Nurse managers are more likely to be involved in philosophy, goals, and objectives of the organization?
what type of planning? a. Mission statement
a. Long-range planning b. Marketing analysis
b. Strategic planning c. Vision
c. Operational planning d. Values
d. Short-term planning
13. When developing or reevaluating a philosophy, the
2. The chief nursing officer was asked by the hospital manager should consider theory, education, practice, research, and the role
administrator to assume the responsibility of determining how many nurses of nursing in the total organization. Which nursing theorist provided the
would be needed when the new surgical center opened in 2 years. This is most useful model for an acute care setting?
what type of planning? a. Rogers
a. Internal environmental analysis b. Roy
b. Planning for external opportunities and threats c. Widenbach
c. Operational planning
d. Levine b. Organizational values, clinical expertise, and the best research
evidence
14. How does an institution organize to meet the c. Patient values, medical expertise, and the best research evidence
institution’s goals? d. Organizational values, medical expertise, and the best research
a. By defining the goals evidence
b. By staffing to accomplish the goals
c. By stimulating personnel toward accomplishment of the objectives 25. A staff nurse is transferred from the surgical unit to a
d. By comparing the results with the objectives to evaluate medical intensive care unit. In the new unit, the staff nurse will most likely
accomplishments be at which level of competency as defined by Benner?
a. Novice
15. Which of the following individuals or groups influence b. Advanced beginner
how institutional goals are determined by the organization? c. Advanced
a. Staff nurses d. Competent
b. Patient care coordinators
c. Vice president for nursing
d. Board of directors Chapter 9: Financial Management, Cost Containment, and Marketing

16. A staff nurse participates in the determination of goals

by establishing: 1. Health care costs continue to increase. All of the
a. Institutional goals and objectives following contribute to rising health care costs except:
b. Goals and objectives for the nursing service a. Aging population
c. Unit goals and objectives b. Increasing number of diseases requiring acute care
d. Outpatient service goals and objectives c. Increased health care needs
d. Increasing number of uninsured people
17. The hospital educator established objectives for the
education department. The following is an example of an objective: 2. Which of the following reimburses according to the
a. Develop and implement staff development programs to meet the need cost of treatment of specific diagnosis-related groups (DRGs)?
for increased knowledge a. Health promotion programs
b. Develop and implement at least 12 staff development programs by the b. Managed care systems
end of the fiscal year c. Prospective reimbursement system
c. Evaluate, revise, and implement the orientation program for new d. Health maintenance organizations
personnel
d. Develop, implement, and evaluate in-service programs regarding new 3. A system in which a fixed payment is given to a care
products provider per health plan participant per month for delivery of a specified
amount of health care services is known as:
18. Policies and procedures serve many purposes in an a. Managed care
organization. Which of the following purposes of policies and procedures is b. Health maintenance organization
the most important for the nurse manager? c. Individual provider arrangements
a. They serve as a basis for future decisions and actions. d. Capitation
b. They serve as a means to plan the unit budget.
c. They serve as a means to control performance. 4. What has been the impact of managed competition on
d. They serve as a means to increase consistency of action. nursing?
a. Large differential in salary among nurses with an associate degree,
19. At a magnet hospital, the nurses’ council committee bachelor of science degree, and master of science degree
developed a new policy regarding the implementation of a computerized b. Increased registered nurse staffing
charting system. This policy can best be described as: c. Increased use of advanced practice nurses
a. Obsolete d. Use of licensed practical nurses/licensed vocational nurses as
b. Originated utilization reviewers
c. Appealed
d. Imposed 5. How should nurse managers face the challenge of
globalization?
20. Procedure manuals provide: a. Participate in the World Health Organization to help prevent a
a. An abbreviated course of action pandemic
b. A basis for orientation and staff development b. Assure that adequate disease testing equipment is in place
c. A resource only for nurse managers c. Conduct research to develop new diagnostic tests
d. A low degree of regularity d. Screen all patients to prevent an epidemic

21. While writing a procedure for the administration of 6. A nurse manager acts as a fiscal manager on the unit.
chemotherapy, the staff nurse included all of the following except: The nurse manager’s most likely duty is to:
a. Materials needed and how to locate them a. Be proactive in the fiscal planning
b. Methods for recycling the materials used b. Guide the formulation of justification for requests for resources
c. The physician’s responsibilities c. Coordinate the fiscal planning
d. Appropriate charting d. Analyze expenses

22. The planning process is a critical element for nursing 7. A nurse manager has to submit a proposal to the
management. One consequence of planning is: administration for the staffing needs of the intensive care unit. The nurse
a. Vision manager will be working with what type of budget?
b. Values a. Operating budget
c. Mission statement b. Revenue-and-expense budget
d. External assessment c. Personnel budget
d. Capital expenditure budget
23. Evidence-based practice information is a most useful
resource for the development of: 8. The nurse manager assessed the need for a new
a. The mission statement flotation bed for patients with severe decubitus ulcers on the unit. The nurse
b. Policies and procedures manager reported this information to the chief nursing officer, who reviewed
c. An evaluation process which budget to plan for replenishment of this equipment on the unit?
d. An environmental analysis a. Operating budget
b. Capital expenditure budget
24. The Institute of Medicine defines evidence-based c. Cash budget
practice as the integration of: d. Flexible budget
a. Patient values, clinical expertise, and the best research evidence
9. The nurse manager reviews the unit’s budget
quarterly. One advantage of such a budget review is that: wealthy community leaders seeking donations to help build an extension to
a. It is time consuming and expensive the hospital. This target group is an example of:
b. Corrective measures can be taken a. An exchange public
c. The budget converts organizational performance into monetary values b. An internal public
d. The budget supersedes the agency goals c. A sought public
d. An unwelcome public
10. The hospital established the financial responsibilities
of the personnel who are part of the budgetary process. The function of the 20. The hospital has established a wellness center that
nurse managers and department heads during the budgetary process is to: provides health education programs. To advertise this new service, the
a. Provide general planning expertise hospital conducts what type of marketing?
b. Formulate and execute the budget by using guidelines a. Mass marketing
c. Establish a completion timetable b. Social marketing
d. Prepare and review goals and objectives, and compile the budgets for c. Product-variety marketing
their departments d. Exchange marketing

11. The hospital is promoting a healthy living program for 21. A marketing audit of a small rural town is performed to
its employees. On what part of cost containment is the hospital focusing? see if the community would be interested in having a clinic that specializes
a. Cost fairs in women’s and children’s services. This is what type of market targeting?
b. Cost management a. Differentiated marketing
c. Cost avoidance b. Comprehensive marketing
d. Cost reduction c. Concentrated marketing
d. Undifferentiated marketing
12. The nurse manager needs to determine the most
economical level of inventory, because supplies represent a significant cost 22. A wellness clinic was promoting a new weight loss
factor. To keep costs down, the nurse manager places small orders capsule that was approved by the Food and Drug Administration. Over the
frequently. This is an example of reducing what kind of cost? last quarter, the clinic’s data revealed an increase in the sale of the product.
a. Order cost This is an example of what stage of the product’s life cycle?
b. Carrying cost a. Introduction stage
c. Short cost b. Growth stage
d. Stock-out cost c. Maturity stage
d. Market decline stage
13. A nurse manager uses what technique to help control
costs? 23. With very few Food and Drug Administration–
a. Delegating appropriate tasks to unlicensed personnel approved nonprescription weight loss drugs on the market, the
b. Comparing costs with those of other departments pharmaceutical companies that produce these over-the-counter
c. Calculating the break-even points on an item medications can establish what kind of pricing goal?
d. Conducting comparisons in monetary units a. Cost-plus pricing
b. Profit-maximizing pricing
14. The chief nursing officer needed to make changes in c. Sliding payment scale
the staffing budget because the hospital was opening an additional 10 beds d. Price-discrimination pricing
to the emergency department. The nursing administrator had to look at
what type of costs? 24. The hospital used promotions that were not paid for
a. Variable costs by the hospital. What type of publicity tool did the hospital use?
b. Sunk costs a. Public service announcements
c. Semivariable costs b. Billboard advertising
d. Marginal costs c. Telephone stickers
d. Fund raising
15. The nurse manager wanted to implement a new
indirect cost savings strategy on the unit. An example of an indirect cost 25. Marketing promotion informs potential customers of
savings strategy is: the existence and availability of products and services. Because consumers
a. Instituting a new 15-minute break policy have become more knowledgeable about health care, hospitals have had to
b. Holding staff meetings on company time become very creative in their marketing promotions. Hospitals understand
c. Charging for the coffee served to employees that marketing promotion leads to:
d. Eliminating the nurses’ lounge area a. Reutilization of services
b. Underutilization of services
16. The hospital implemented several cost-cutting c. Narrowing of services to a select group
strategies to keep from closing. One strategy was the support of early d. High bidding to get the business
retirement. What kind of strategy can the nurse manager use to keep up the
morale of the unit?
a. Initiate an across-the-board pay cut to be fair to everyone Chapter 10: Organizational Concepts and Structures
b. Acknowledge the staff’s good work
c. Encourage staff members to seek other positions for job security
d. Give a pay raise to the remaining employees 1. The nurse manager resigned from an organization
that had formal channels of communication to begin working at an
17. The nurse manager used the traditional model for organization with a flat structure. The nurse manager can expect to find
costing out nursing services. In this model, the amount of nursing time per which of the following?
intensity level (NT) is calculated based on what? a. Division of labor with simplification of work
a. PPOs b. Delimitation of responsibilities
b. MHOs c. Performance of multiple work tasks
c. DRGs d. Focus on product centricity
d. IPAs
2. In response to the rising costs of health care,
18. One difference between the traditional model and the hospitals have developed population-based health programs that focus on
McCloskey model for costing out nursing services is that the McCloskey a given disease or health condition and provide care to groups needing
model uses: specialized health services. These programs, developed as managed care
a. Average nursing hourly salary (ANHS) health plans, are termed:
b. Benefits across the institution (BAI) a. Disease management programs
c. Indirect cost amount (ICA) b. Coordination of care
d. Nursing intervention (NI) c. Modular care
d. Consolidation of health plans
19. The hospital’s board of directors sent letters to
3. As a leader in the organization, the chief nursing
officer should: c. Dual management system
a. Model the use of decentralized power d. Organic structure
b. Model the use of centralized power
c. Follow the chain of command
d. Create a bureaucratic environment 14. A staff nurse who recently graduated from a health
systems management graduate program was relieved of her duties on the
4. The nurse manager of the unit is responsible for: unit and given a temporary assignment along with other staff members who
a. Encouraging downward communication were working on their certifications. The staff members were participating
b. Establishing a chain of command in:
c. Facilitating the formal group a. Bureaucratic management
d. Modeling the use of centralized power b. A task force
c. A line and staff model
5. The nurse manager develops an organizational chart d. An adhocracy
that includes all of the following except:
a. Formal organizational relationships 15. Which of the following is an important principle that
b. Informal organizational relationships maximizes the efficiency of the bureaucratic structure in an organization?
c. Areas of responsibility a. Each staff member may have more than one boss.
d. Channels of communication b. Verbal descriptions of the roles of staff members are sufficient.
c. Authority and responsibilities of staff members should be defined in
6. In what is called a “new” organizational structure, writing.
versus a traditional structure, what is true of the chain of command? d. Role clarity guarantees effective delegation.
a. Communication flows from the top down.
b. Authority and responsibility are aligned. 16. To increase performance effectiveness, the nurse
c. Informal communication prevails. manager must:
d. Authority and responsibility are delegated to the lowest operational a. Ensure increased production
level. b. Give employees informal authority
c. Decrease delegation of tasks
7. A staff nurse was recently promoted to a case d. Provide general supervision
manager position. With this promotion, the staff nurse’s responsibilities now
include: 17. An advanced practice nurse was hired to help
a. Making decisions for the organization as a whole establish a trauma unit. While working on the project, he found that he had
b. Long-term planning and policy making to report to the chief nursing officer and the newly hired medical director of
c. Involvement in the specific unit’s workflow the trauma unit. This organizational design is known as:
d. More bedside nursing involvement a. A functional line
b. A matrix
c. A project line
8 A nurse manager has begun working in an d. An adhocracy
organization with decentralized decision making. Decentralized decision
making allows the nurse manager to: 18. A hospital decided to restructure the organization by
a. Make decisions effectively changing from a bureaucratic model to European-style management. The
b. Make long-range plans primary difference between these two styles is that European-style
c. Develop organizational goals management:
d. Initiate policy development a. Has a rigid line of authority
b. Uses a board to make policy decisions
9. An urban hospital decided to sponsor a school-based c. Has inflexible boundaries separating jobs and divisions
clinic in a nearby ghetto area as part of the services of the hospital. The d. Shifts personnel and disrupts training
service is viewed as:
a. Departmentalization by specialty 19. The dean of the school of nursing decided to
b. Departmentalization by function implement a shared governance model. The principal foundation of this
c. Departmentalization by territories model is:
d. Departmentalization by client a. Self-governance
b. Autocratic leadership
10. A hospital recently hired a quality improvement c. Participatory management
director whose position can be viewed on the organizational chart. The d. European-style management
function of this position in the chain of command is to:
a. Offer counsel on managerial problems 20. To survive the changes in the health care field, many
b. Restrain line authority nurses have become entrepreneurial and have established their own
c. Perform the routine work programs or agencies to hire others to provide care to the community. What
d. Serve in an advisory capacity type of organizational model would best fit this approach?
a. Self-governance
11. The roles of the nurse manager throughout b. Shared governance
organizational redesign, restructuring, and reengineering include all of the c. Corporate model
following except: d. Mixed model
a. Team building
b. Change initiation 21. One way that nurse leaders who are employed by an
c. Case management organization can best fit into a corporate model instead of a traditional
d. Cost reduction bureaucratic model is to:
a. Meet every 3 months to approve by-laws
12. On the unit, the nurse manager assigned one staff b. Increase autocratic leadership
member to pass medications and give treatments. In this case, span of c. Create a network instead of preserving a pyramid
control is defined in terms of: d. Establish vertical communications
a. Function
b. Product 22. A hospital established a professional partnership with
c. Service a local nursing program. A joint practice agreement was signed between
d. Region the two agencies. This is an example of what type of multiorganizational
arrangement?
13. In a large medical center, the chief nursing officer met a. Informal affiliations
with the vice president of information systems to schedule training for the b. Formal affiliations
nursing staff on the new information systems that were to be installed. What c. Shared or cooperative services
type of organizational structure does this medical center have? d. Consortia
a. Shared governance structure
b. Line and staff structure
 23. In response to managed care, many hospitals have
set up disease management programs. One benefit of such programs is: 7. A nurse manager motivates her employees and
a. The focus primarily on acute illnesses serves on community service boards as a representative of the
b. The focus primarily on the elderly with acute illnesses organization. The nurse is said to be:
c. The focus on coordination of care of people at risk a. A hero
d. The focus on tertiary prevention for all persons b. A legend
c. A metaphor
24. A nurse manager was concerned about the d. An overachiever
employees of her unit when the hospital for which she was working merged
with another health care system. She explained to her staff what was not 8. Because the nurse manager has served the
going to change, what changes would take place, and the importance of the organization through two corporate buyouts, he has developed the skills of
changes. The nurse manager was participating in what phase of this new steward, inspirer, and promoter. This nurse manager is most likely to create
integration of health care systems? what type of culture?
a. Assessment phase a. Control culture
b. Planning and design phase b. Collaborative culture
c. Implementation phase c. Competence culture
d. Development phase d. Cultivation culture

25. Nurses need to be prepared for globalization and its 9. Student nurses joined a professional organization for
implications for health care. Nurses would be most likely to focus on which student nurses while enrolled in a baccalaureate nursing program. This is
of the following as the groundwork for the management of outcomes in an example of:
global health care? a. A macrosystem
a. Information technology b. A subculture
b. Case management and clinical pathways c. Social cohesiveness
c. Complexity of connections leading to globalization d. A counterculture
d. Amount of medicine required to treat diseases
10. The hospital was experiencing low staff morale and
Chapter 11: Organizational Culture, Change, and Innovatio decreased productivity after it merged with another corporation. The staff
1. The nurse manager assessed the culture of the unit from the hospital became territorial when staff members from the other
before instituting policy changes. The nurse manager found that the corporation were scheduled to work with hospital staff. This is an indication
environmental culture fostered teamwork and consensus building. This best that the change induced by the merger has been influenced by:
describes what type of culture? a. Counterculture
a. Individualistic culture b. Internal forces
b. Collective culture c. External forces
c. Expert culture d. Microsystems
d. Transculturalism
11. A nurse manager was asked to select nurses for a
2. The nurse manager attempted to help staff members new geriatric unit and interviewed several nurses for the job of patient care
adjust to the new organizational merger by explaining the need for changes coordinator. The nurse who was selected has a master’s degree in adult
and modeling tolerance of these changes. The nurse manager health with a focus on gerontologic nursing. This nurse manager used
demonstrated what type of tolerance? which kind of change strategy?
a. Cognitive dissonance a. Empirical-rational strategy
b. Tolerance of others b. Normative-reeducative strategy
c. Tolerance of ambiguity c. Power-coercive strategy
d. Tolerance of insolubility d. Interactional change strategy

3. With the new career ladder in place, the hospital 12. First-line managers can apply Lewin’s framework for
expects nurse managers to attend budget meetings, prepare staffing planned change to nursing care. Which part of Lewin’s framework is
schedules, and enroll in a health management systems graduate program. comparable to the evaluation step of the nursing process?
One nurse manager with three small children is at high risk for: a. Unfreezing phase
a. Role theory b. Moving phase
b. Role structure c. Refreezing phase
c. Role learning d. Force-field analysis
d. Role stress
13. A nurse manager requests in-service training about
4. The hospital’s mission statement includes the phrase, the new computerized system that is to be implemented once a planned
“We are committed to providing multicultural services.” An example of merger between the nurse manager’s agency and another agency is
carrying out this mission is: completed. Based on Lewin’s force-field analysis, the nurse manager’s
a. Supporting dialogue between individuals of different cultures strategy is to:
b. Ensuring that patients of different cultures have translation services a. Increase the restraining forces and strengthen the driving forces
available b. Increase the restraining forces and decrease the driving forces
c. Providing services only for English-speaking patients c. Reduce the restraining forces and strengthen the driving forces
d. Excluding different cultural practices d. Reduce the restraining forces and decrease the driving forces

5. The hospital has planned a day of celebration called 14. In a staff meeting, the staff complain that they would
Cultural Diversity Day. At this celebration, employees of different cultures like to have more events that allow them to socialize with their co-workers.
are allowed to bring their favorite foods to share with other employees. The The nurse manager recognizes that there is a culture gap on the unit. The
hospital is demonstrating what stage of intercultural sensitivity? culture gap relates to which of the following?
a. Denial of differences a. Task support norms
b. Minimization of differences b. Task innovation norms
c. Adaptation to differences c. Social relationship norms
d. Integration of differences d. Personal freedom norms

6. A Hispanic nurse was interviewed for a position at a 15. The hospital has approved the nurse manager’s
small rural hospital. The nurse was told that the hospital has written policies suggestion to have more social activities for employees. The hospital will
regarding the provision of equal support and career development resources now implement the next track of Kilmann’s process for organizational
to all employees. This hospital deals with cultural diversity through: planned change, which is:
a. Intercultural sensitivity a. Management skills
b. Cultural awareness building b. Scheduling of the tracks
c. Discrimination control c. Strategy structure
d. Prejudice reduction d. Reward system
 a. Moving backward
b. Advancing
c. Oscillating
d. Restructuring
16. The staff members question the nurse manager about
the effects of the new computerized charting system on their workload. 25. Two hospitals want to assess the organizational
They are unsure if the computerized charting system will be easy to learn. culture of each agency to predict the sources of resistance to change
The staff members are in which of the stages of the innovation process as before they merge. What type of tool can they use?
defined by Rogers? a. Value compass
a. Knowledge b. Organizational audit
b. Persuasion c. Competing Values Framework
c. Decision d. Organizational Culture Assessment Instrument
d. Confirmation

17. Several senior nurses have opposed the installation

of the new computerized charting system. The nurse manager hears these
senior nurses make negative comments to the novice nurses about the new
system. According to Rogers, the senior nurses are which kind of adopters?
a. Innovators
b. Early adopters
c. Laggards
d. Rejecters

18. A hospital specializing in women’s and children’s

services opened in a mid-sized town. As the organization grew, more staff
members were needed to accommodate the new services added. The
hospital developed job descriptions, policies, and procedures for the
employees working in the new services. This hospital was going through
which developmental stage?
a. Birth
b. Youth
c. Maturity
d. Termination

19. Within the organization, staff members continued to

express negative comments about the changes that had occurred when a
merger took place. The staff felt that after the merger, the new organization
had lost its vision and mission. The members of this new organization were
experiencing:
a. An adaptive culture
b. A dysfunctional culture
c. A cultural rut
d. Culture shock

20. When the hospital merged with another institution,

many workers decided to retire instead of remaining to work for the new
organization. These employees are said to be:
a. Disengaged
b. Disidentified
c. Disoriented
d. Disenchanted

21. Changes are disturbing to those affected, and

resistance often develops. All of the following are causes of resistance to
change except:
a. Threatened self-interest
b. Complacency
c. Security
d. Previous long-term system stability

22. The nurse managers met with the chief nursing officer
before the organization began downsizing. Some of the senior nurse
managers complained about the downsizing after the meeting. In terms of
their level of commitment to the change, these senior nurse managers
could be categorized as:
a. Champions
b. Overt resisters
c. Covert resisters
d. Skeptics

23. One way that administration can handle incompetent

executives is to:
a. Hire new managers
b. Move them from line to staff authority
c. Terminate their employment
d. Counsel them toward satisfactory performance

24. A year after the organization has completed a merger,

patient surveys show that patient satisfaction has increased by 50%. The
organization attributes this change to the hiring of a case manager. This
organization is said to be: